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Concerns over personal preference
The experfs research
Concerns over personal preference Q. We have a new 06 GYN doctor who has just joined our staff. He is not a new doctor for he has served a number of years in the service. We noticed he does not take off his wedding ring when he scrubs. When the ORS called this to his attention and told him the ring should be removed because of the bacteria under the ring, the doctor said he never takes off his ring when he scrubs, for the plqce under his ring was too small to harbor bacteria. Now all of us are wondering who is right?
A. Your operating room supervisor is right. A study in Lancet, April 6, 1968, p 709 found the mean bacterial count per ml of washings from fingers wearing rings was 647 as compared to the mean count of 86 from the ring fingers of the hands not wearing rings. These findings seem reason enough for removing all rings from fingers while in the OR. Q. Should gastro-intestinal tract surgery technique be a matter of OR policy or be that of the individual surgeon’s preference?
March 1972
a: Should the same technique be followed on upper gastro-intestinal fract surgery as well as the lower intestinal tract?
A. Bowel technique or gastric routine i s the procedure necessary to prevent spread of contamination within the peritoneal cavity and provide a clean incisional closure after the gastro-intestinal tract has been closed. During upper gastro-intestinal surgery it i s just as important to follow the same procedure to prevent chemical contamination and irritation caused by spillage of the contents of stomach or small intestine. Immediately prior to the opening of the gastro-intestinal tract clean towels are placed around the operative area. Then warm moist laparotomy tapes are placed around the site of the incision to protect the viscera and abdominal wall tissues. These can be isolated by covering them with sterile plastic material. Since the scrub nurse is a necessary and vital part of the team, we feel she should be an active participant throughout this
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procedure even though some authors suggest she remain outside the contaminated area. If the "closure tray" technique i s employed, i t allows the scrub nurse to be of assistance during the closure of the GI tract. However, once the tract is opened the scrub nurse does not go to her back table. AS soon as the tract i s closed, towels, drapes and tapes are discarded as well as all sponges and instruments. At this time i t i s recommended that the entire team change gown and gloves. 4fter the change of gown and gloves the patient i s adequately redraped and the scrub nurse at this time brings up the Mayo stand, with the closure instruments and sutures to the field. This Mayo stand was set up prior to the start of the operation and remained covered until needed. The doctor then proceeds with the abdominal closure. An alternative to the closure tray technique i s the basin technique. This technique in comparison to the closure tray technique has several drawbacks. One being the chance of contamination of the major instrument tray i s fairly high. However, the
technique i s as follows. The scrub nurse remains outside the contaminated area and keeps her gown and gloves and instrument table sterile. This i s accomplished b y dropping all sponges, instruments and sutures onto a towel placed just below the incision. As the surgeons help themselves, they also discard all soiled sponges and instruments into a basin placed on the field for this purpose. Once the tract is opened, the scrub nurse does not touch anything on the field. After the tract has been closed, but before the surgeon changes gown and gloves, he hands the basin of discarded, soiled items, off the field to the circulating nurse. Standardized procedures adhered to by all surgeons on a staff will eliminate confusion and will insure high quality care for every patient. Whichever technique is chosen, it should definitely be a matter of OR policy and not merely left to the discretion of the surgeon or the individual scrub nurse.
c]
-AORN
Professional Advisory C o m m i t f ee
Nursing degree program accelerafed A college graduate can now acquire a boccaloureate degree in nursing in only 12 months o f study under a newly established accelerated program initiated by the St. Louis University School of Nursing and A l l i e d H e a l t h Professions. Since they have already had courses in the natural and social sciences and the h u m a n i t k r , a basic p a r t of the troditional nursing course, the students can devote the entire year to spec i f i c nursing studies. Formerly this t y p e of student would have had t o spend another four years t o attain t h e baccalaureate degree in nursing. I n announcing the new program, Sister M a r y T. N o t h , dean o f the St. Louis University School of Nursing and A l l i e d H e a l t h Professions, said, "It i s believed t o be t h e first school in the nation t o establish such a program." The program covers t w o semesters and t w o summer sessions (one calendar year). I t provides a sequence of learning experiences in nursing developed through integrating and synthesizing previous learning in liberal arts and sciences. "The present health care crisis makes it imperative that t h e School o f Nursing and A l l i e d H e a l t h Professions extend t h e opportunity f o r baccalaureate education in nursing t o ever-broadening sources of potential nurses. The faculty of the School of Nursing and A l l i e d H e a l t h Professions believes the accelerofed progrom t o be one way of d o i n g this," Sister N o t h said. At t h e completion of t h e program, the students are required t o take the same state board nurse licensing examination that the four-year graduate does.
28
AORN Journal
Concerns over personal preference Q. We have a new 06 GYN doctor who has just joined our staff. He is not a new doctor for he has served a number of years in the service. We noticed he does not take off his wedding ring when he scrubs. When the ORS called this to his attention and told him the ring should be removed because of the bacteria under the ring, the doctor said he never takes off his ring when he scrubs, for the plqce under his ring was too small to harbor bacteria. Now all of us are wondering who is right?
A. Your operating room supervisor is right. A study in Lancet, April 6, 1968, p 709 found the mean bacterial count per ml of washings from fingers wearing rings was 647 as compared to the mean count of 86 from the ring fingers of the hands not wearing rings. These findings seem reason enough for removing all rings from fingers while in the OR. Q. Should gastro-intestinal tract surgery technique be a matter of OR policy or be that of the individual surgeon’s preference?
March 1972
a: Should the same technique be followed on upper gastro-intestinal fract surgery as well as the lower intestinal tract?
A. Bowel technique or gastric routine i s the procedure necessary to prevent spread of contamination within the peritoneal cavity and provide a clean incisional closure after the gastro-intestinal tract has been closed. During upper gastro-intestinal surgery it i s just as important to follow the same procedure to prevent chemical contamination and irritation caused by spillage of the contents of stomach or small intestine. Immediately prior to the opening of the gastro-intestinal tract clean towels are placed around the operative area. Then warm moist laparotomy tapes are placed around the site of the incision to protect the viscera and abdominal wall tissues. These can be isolated by covering them with sterile plastic material. Since the scrub nurse is a necessary and vital part of the team, we feel she should be an active participant throughout this
27
procedure even though some authors suggest she remain outside the contaminated area. If the "closure tray" technique i s employed, i t allows the scrub nurse to be of assistance during the closure of the GI tract. However, once the tract is opened the scrub nurse does not go to her back table. AS soon as the tract i s closed, towels, drapes and tapes are discarded as well as all sponges and instruments. At this time i t i s recommended that the entire team change gown and gloves. 4fter the change of gown and gloves the patient i s adequately redraped and the scrub nurse at this time brings up the Mayo stand, with the closure instruments and sutures to the field. This Mayo stand was set up prior to the start of the operation and remained covered until needed. The doctor then proceeds with the abdominal closure. An alternative to the closure tray technique i s the basin technique. This technique in comparison to the closure tray technique has several drawbacks. One being the chance of contamination of the major instrument tray i s fairly high. However, the
technique i s as follows. The scrub nurse remains outside the contaminated area and keeps her gown and gloves and instrument table sterile. This i s accomplished b y dropping all sponges, instruments and sutures onto a towel placed just below the incision. As the surgeons help themselves, they also discard all soiled sponges and instruments into a basin placed on the field for this purpose. Once the tract is opened, the scrub nurse does not touch anything on the field. After the tract has been closed, but before the surgeon changes gown and gloves, he hands the basin of discarded, soiled items, off the field to the circulating nurse. Standardized procedures adhered to by all surgeons on a staff will eliminate confusion and will insure high quality care for every patient. Whichever technique is chosen, it should definitely be a matter of OR policy and not merely left to the discretion of the surgeon or the individual scrub nurse.
c]
-AORN
Professional Advisory C o m m i t f ee
Nursing degree program accelerafed A college graduate can now acquire a boccaloureate degree in nursing in only 12 months o f study under a newly established accelerated program initiated by the St. Louis University School of Nursing and A l l i e d H e a l t h Professions. Since they have already had courses in the natural and social sciences and the h u m a n i t k r , a basic p a r t of the troditional nursing course, the students can devote the entire year to spec i f i c nursing studies. Formerly this t y p e of student would have had t o spend another four years t o attain t h e baccalaureate degree in nursing. I n announcing the new program, Sister M a r y T. N o t h , dean o f the St. Louis University School of Nursing and A l l i e d H e a l t h Professions, said, "It i s believed t o be t h e first school in the nation t o establish such a program." The program covers t w o semesters and t w o summer sessions (one calendar year). I t provides a sequence of learning experiences in nursing developed through integrating and synthesizing previous learning in liberal arts and sciences. "The present health care crisis makes it imperative that t h e School o f Nursing and A l l i e d H e a l t h Professions extend t h e opportunity f o r baccalaureate education in nursing t o ever-broadening sources of potential nurses. The faculty of the School of Nursing and A l l i e d H e a l t h Professions believes the accelerofed progrom t o be one way of d o i n g this," Sister N o t h said. At t h e completion of t h e program, the students are required t o take the same state board nurse licensing examination that the four-year graduate does.
28
AORN Journal